title: Evaluating pleural ADA, ADA2, IFN-γ and IGRA for diagnosing tuberculous pleurisy.
abstract: OBJECTIVE
  Conventional methods for diagnosing tuberculous pleurisy (TB pleurisy) are either invasive or have a long turn-around-time. Performances of pleural adenosine deaminase (ADA), ADA2, interferon-gamma (IFN-γ), and interferon-gamma release assays (IGRA) as diagnostic tools for TB pleurisy were evaluated.
  
  
  METHODS
  Eighty-eight patients with lymphocyte-predominant pleural exudates between June 2010 and March 2011, including 31 with clinically diagnosed TB pleurisy, were prospectively studied. Pleural ADA and ADA2 activity were measured by colorimetric method, IFN-γ levels by enzyme-linked immuno-sorbent assay, and IGRA by enzyme-linked immuno-spot (T-SPOT.TB) assay.
  
  
  RESULTS
  Pleural ADA, ADA2, and IFN-γ levels, but not the proportion of positive T-SPOT.TB assay, were significantly higher in patients with TB pleurisy than in those without TB pleurisy. The area under the receiver-operating-characteristic (ROC) curve was 0.920, 0.893, 0.875, and 0.544 for IFN-γ, ADA2, ADA, and T-SPOT.TB assay, respectively. The combination of ADA ≥ 40 IU/L and IFN-γ ≥ 75 pg/mL yielded a specificity of 100%.
  
  
  CONCLUSIONS
  Pleural ADA, ADA2 and IFN-γ, but not T-SPOT.TB assay, are all sensitive and specific for TB pleurisy. In patients with lymphocyte-predominant pleural exudates, ADA ≥ 40 IU/L and IFN-γ ≥ 75 pg/mL in pleural effusion imply a very high probability of TB pleurisy.
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Rd., 100 Taipei, Taiwan.
authors.forename: Li-Ta
authors.initials: LT
authors.lastname: Keng
authors.forename: Chin-Chung
authors.initials: CC
authors.lastname: Shu
authors.forename: Jason Yao-Ping
authors.initials: JY
authors.lastname: Chen
authors.forename: Sheng-Kai
authors.initials: SK
authors.lastname: Liang
authors.forename: Ching-Kai
authors.initials: CK
authors.lastname: Lin
authors.forename: Lih-Yu
authors.initials: LY
authors.lastname: Chang
authors.forename: Chia-Hao
authors.initials: CH
authors.lastname: Chang
authors.forename: Jann-Yuan
authors.initials: JY
authors.lastname: Wang
authors.forename: Chong-Jen
authors.initials: CJ
authors.lastname: Yu
authors.forename: Li-Na
authors.initials: LN
authors.lastname: Lee
mesh_terms: D048868:Adaptor Proteins, Signal Transducing / Q000032:analysis*; D000243:Adenosine Deaminase / Q000032:analysis*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001826:Body Fluids / Q000737:chemistry*; D019411:Clinical Laboratory Techniques / Q000379:methods*; D003124:Colorimetry / Q000379:methods; D004268:DNA-Binding Proteins; D005260:Female; D006801:Humans; D007118:Immunoassay / Q000379:methods; D007371:Interferon-gamma / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014157:Transcription Factors / Q000032:analysis*; D014396:Tuberculosis, Pleural / Q000175:diagnosis*
chemical_list: D048868:Adaptor Proteins, Signal Transducing; D004268:DNA-Binding Proteins; C097695:TADA2A protein, human; D014157:Transcription Factors; D007371:Interferon-gamma; C548482:ADA protein, human; D000243:Adenosine Deaminase
keywords: Adenosine deaminase; Adenosine deaminase 2; Interferon-gamma; Interferon-gamma release assay; T-SPOT.TB assay; Tuberculous pleurisy